By MHAUS President Henry Rosenberg MD, CPE
Earlier this year I described what lies ahead for MHAUS. I laid out an ambitious program for the year. I am pleased to report that with one or two exceptions the goals were largely met. Here are some of the programs and accomplishments of 2010:
- A comprehensive hands-on guide to performing an MH drill including a video of a mock drill done at the Bowman Gray School of Medicine. The kit is being used in hundreds of facilities, putting it to good use in preparing their teams for an MH crisis.
- A guide to developing a protocol for transfer of an MH patient from an outpatient surgery center to a hospital. Developed in partnership with the Ambulatory Surgery Foundation (ASF), we introduced a poster size Transfer of Care Guideline at the Ambulatory Surgery Center Association and American Society of Anesthesiologistsâ?? annual meetings. This guideline is available for purchase on both the MHAUS and ASCA web sites, and is meant to help prepare an ambulatory care center for moving an MH patient in crisis to a hospital for definitive treatment in a safe and effective manner. The guide is not a protocol, like our MH treatment protocol, because there are a wide variety of ambulatory surgery facilities with differing resources, located at variable distances from hospitals. Emergency medicine physicians, anesthesiologists, emergency medicine technicians and representatives of the ambulatory surgery associations worked with MH experts to produce this first of its kind guide.
- A comprehensive conference on current scientific understanding of MH and related disorders. Held at Mercy Hospital of the University of Pittsburgh (the site of the North American MH Registry), the conference was attended by close to 100 clinicians and scientists. A report is being prepared for publication.
- Greater outreach to Canadian anesthesiologists and MH patients through exhibiting at the Canadian Anesthesia Society meeting as well as at a patient/provider conference in Toronto.
- Presentations about MH posted on You Tube.
- The introduction of an interactive app for the iPhone and other Apple products for diagnosing and managing MH. The app is meant to provide guidance and suggestions in clinical diagnosis and treatment of MH as well a means to record the events.
- Adoption of MHAUS guidelines for availability of dantrolene at hospitals and ambulatory centers by the main accreditation organizations and the Centers for Medicare and Medicaid Services, i.e., 36 vials available within five minutes. In addition, a requirement for annual training in MH.
- The adoption by the American Society of Anesthesiologists of a guideline for intraoperative temperature monitoring more in line with the guideline recommended by our Professional Advisory Council for many years.
- The publication of several important articles by members of the North American MH Registry.
- Of course, all of these projects took place at the same time MHAUS exhibited at 6 scientific and health care-oriented meetings, maintained our active hotline, posted new information including a challenging case of the month on our web site, and produced many publications.
None of this could have been done without the dedicated work of our Board, volunteer hotline consultants, members of our Professional Advisory Council and many individuals and organizations who so generously contribute to MHAUS. On behalf of our Board of Directors, I want to thank them for your help and support. Whether you are a student member of MHAUS, a regular member or a contributor, we appreciate your vote of confidence in us.
Of course, the work of MHAUS does not stop, since we still hear about deaths and near misses from MH and there is so much more to learn about MH and its presentations. We also now know that a small subset of MH-susceptibles are at risk for muscle breakdown in a hot environment together with marked exertion. At present, unfortunately, we cannot identify those at risk. There are a few investigators focusing on this problem. MHAUS is encouraging further work in the field through small grants, publishing information on our web site and in our various other publications as well through support of the North American MH Registry, a database of patient-specific information concerning MH and MH-like events.
What then are some of the goals for 2011?
There are many, but here are a few of the top items on the list:
An immediate goal is to synthesize the information from the April Scientific Conference suitable for publication in a major anesthesia journal. We hope to have it done within the first quarter of 2011.
Another major effort is to alert surgeons, anesthesia providers, nurses and managers of outpatient ambulatory center and office-based surgery facilities to the importance of having a specific transfer protocol when a patient experiences an MH crisis. With the cooperation and guidance of those who helped put the Transfer of Care Guideline together, we will roll out a program to assist these centers in developing a protocol that is suitable and tailored to their unique situation. This will also mean working with emergency room personnel as well as medical transport professionals. I believe the lessons learned about transfer of care can be applied to many other conditions and situations.
It would take me many more pages to describe the other efforts underway to improve patient safety for MH susceptibles and their families; inform the medical community on how to recognize and manage MH; provide an accurate test for MH susceptibility that is less invasive than the muscle biopsy contracture test; as well as to understand the relation between MH and other muscle and heat related disorders.
I hope that you can appreciate the hard work and thought that goes into creating programs that help patients and assist providers in caring for MH susceptibles. If so, please contribute generously to our efforts.
As always, if you wish to contact me or MHAUS staff, we are available to answer your questions to the best of our ability. Thank you.
The entire MHAUS organization wishes you a joyous and healthy holiday season.